Podiatric Dermatology Quiz: What Is Your Diagnosis?

Can you identify the type of dermatitis shown in the photo at the left?

The condition depicted is a chronic pruritic skin disorder often associated with a personal or family history of asthma, hay fever, allergic rhinitis and eczema. Most cases first become apparent in early childhood. An onset of the disorder after the age of 14 is uncommon.

The hallmark of the condition is severe pruritus. Incessant scratching leads to lichenification, a thickening of the skin. The skin is xerotic and over time, the disease tends to localize to the hands, posterior neck and the antecubital and popliteal fossae. Aggravating factors include cold weather, harsh soaps and detergents, and wool clothing. Treatment involves avoidance of risk factors and the restoration of skin barrier function by using moisturizers.

This chronic, relapsing disease is usually inherited as patients will present with either a personal or family history of asthma, allergic rhinitis, eosinophilic esophagitis, and skin rash appropriate for their age. Patients often describe this as an “itch that gets a rash.” This type of dermatitis is intensely pruritic and does not have a primary lesion as is the case with psoriasis and lichen planus.

What is your diagnosis?

• Nummular dermatitis
• Stasis dermatitis
• Atopic dermatitis
• Allergic contact dermatitis
• Irritant contact dermatitis

Please leave your answers in the comment section below. I’ll share the answer in the next couple of days on Facebook and Twitter, and at the end of my next blog.

Editor’s note: This blog is adapted from the forthcoming book, Skin Disease Of The Lower Extremities: A Photographic Guide, from Tracey Vlahovic, DPM, and Stephen M. Schleicher, MD. The book will be published in 2012 by HMP Communications.